Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis
Download started
OkIntroduction
Methods
Search strategy and selection criteria
Data analysis
Role of the funding source
Results
| Country | Study design | Population description | Lifetime prevalence of TBI | Incidence of TBI | TBI ascertainment method | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Setting | Sample size | Age, years* | Female, n/N (%) | Any severity, n/N (%) | Moderate or severe, n/N (%) | |||||
| Andersen et al
(2014)27
27.
Andersen,
J
∙
Kot,
N
∙
Ennis,
N
∙
et
al.
Traumatic
brain
injury
and
cognitive
impairment
in
men
who
are
homeless
Disabil
Rehabil.
2014;
36:2210-2215
|
Canada | Cross-sectional | Shelter for homeless men | 34 | 58·8 | 0/34 | 12/34 (35·3%) | 11/34 (32·4%) | . | Questionnaire or screening tool: Brain Injury Screening Questionnaire |
| Bacciardi et al
(2017)28
28.
Bacciardi,
S
∙
Maremmani,
AG
∙
Nikoo,
N
∙
et
al.
Is
bipolar
disorder
associated
with
tramautic
brain
injury
in
the
homeless?
Riv
Psichiatr.
2017;
52:40-46
|
Canada | Cross-sectional | Community agencies that serve homeless individuals (shelters, drop-in centres, outreach teams, inpatient programmes, and criminal justice programmes) | 416 | 39·9 | 117/416 (28·1%) | 277/416 (66·6%) | 108/198 (54·5%)§ | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?” |
| Barnes et al (2015)29
29.
Barnes,
SM
∙
Russell,
LM
∙
Hostetter,
TA
∙
et
al.
Characteristics
of
traumatic
brain
injuries
sustained
among
veterans
seeking
homeless
services
J
Health
Care
Poor
Underserved.
2015;
26:92-105
|
USA | Cross-sectional | VA service clinics for veterans seeking homeless services | 229 | 51·8 | 9/229 (3·9%) | 207/229 (90·4%) | 63/229 (27·5%) | . | Structured interview: OSU TBI-ID |
| Bremner et al
(1996)30
30.
Bremner,
AJ
∙
Duke,
PJ
∙
Nelson,
HE
∙
et
al.
Cognitive
function
and
duration
of
rooflessness
in
entrants
to
a
hostel
for
homeless
men
Br
J
Psychiatry.
1996;
169:434-439
|
UK | Cross-sectional | Hostel for homeless men | 62 | NR | 0/62 | 29/62 (46·8%) | . | . | Single question or series of questions: specific questions NR |
| Brenner et al
(2017)31
31.
Brenner,
LA
∙
Hostetter,
TA
∙
Barnes,
SM
∙
et
al.
Traumatic
brain
injury,
psychiatric
diagnoses,
and
suicide
risk
among
Veterans
seeking
services
related
to
homelessness
Brain
Inj.
2017;
31:1731-1735
|
USA | Cross-sectional | VA service clinics for veterans seeking homeless services | 309 | 52·3 | 11/309 (3·6%) | 282/309 (91·3%) | 90/309 (29·1%) | . | Structured interview: OSU TBI-ID |
| Brown et al (2013)32
32.
Brown,
RT
∙
Kiely,
DK
∙
Bharel,
M
∙
et
al.
Factors
associated
with
geriatric
syndromes
in
older
homeless
adults
J
Health
Care
Poor
Underserved.
2013;
24:456-468
|
USA | Cross-sectional | Emergency, transitional, and day shelters | 250 | 56·2 | 48/250 (19·2%) | 147/250 (58·8%) | . | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?” |
| Bymaster et al
(2017)33
33.
Bymaster,
A
∙
Chung,
J
∙
Banke,
A
∙
et
al.
A
pediatric
profile
of
a
homeless
patient
in
San
Jose,
California
J
Health
Care
Poor
Underserved.
2017;
28:582-595
|
USA | Cross-sectional | Health care clinic sites for a US county homeless programme | 127 | 48 | 40/127 (31·5%) | 97/127 (76·4%) | 38/127 (29·9%) | . | Structured interview: OSU TBI-ID |
| Cotman et al (1997)34
34.
Cotman,
A
∙
Sandman,
C
Cognitive
deficits
and
their
remediation
in
the
homeless
J
Cogn
Rehabil.
1997;
15:16-23
|
USA | Pre-test/post-test | Residential programme to assist recovery from homelessness | 24 | 30·6 | 11/24 (45·8%) | 2/24 (8·3%) | . | . | Other: NR |
| Gargaro et al
(2016)35
35.
Gargaro,
J
∙
Gerber,
GJ
∙
Nir,
P
Brain
injury
in
persons
with
serious
mental
illness
who
have
a
history
of
chronic
homelessness:
could
this
impact
how
services
are
delivered?
Can
J
Commun
Ment
Health.
2016;
35:69-77
|
Canada | Cross-sectional | Clients seeking support from an Assertive Community Treatment Team in a downtown urban setting | 48 | 43·4 | 15/48 (31·3%) | 27/48 (56·3%) | . | . | Structured interview: OSU TBI-ID |
| Gonzalez et al
(2001)36
36.
Gonzalez,
EA
∙
Dieter,
JN
∙
Natale,
RA
∙
et
al.
Neuropsychological
evaluation
of
higher
functioning
homeless
persons:
a
comparison
of
an
abbreviated
test
battery
to
the
mini-mental
state
exam
J
Nerv
Ment
Dis.
2001;
189:176-181
|
USA | Cross-sectional | Health care clinic associated with community shelter and outreach programme for homeless individuals | 60 | 39·8 | 24/60 (40·0%) | 23/60 (38·3%) | . | . | Single question or series of questions: documented instance of LOC or patient self-report of serious blow to the head or LOC; specific questions NR |
| Hurstak et al
(2017)37
37.
Hurstak,
E
∙
Johnson,
JK
∙
Tieu,
L
∙
et
al.
Factors
associated
with
cognitive
impairment
in
a
cohort
of
older
homeless
adults:
results
from
the
HOPE
HOME
study
Drug
Alcohol
Depend.
2017;
178:562-570
|
USA | Cross-sectional | Overnight shelters, homeless encampments, meal programmes, and recycling centres | 343 | 58 | 79/343 (23·0%) | 149/343 (43·4%) | . | . | Single question or series of questions: participants asked to report the number of lifetime head traumas they had experienced, and detailed information was collected for up to three instances that resulted in LOC or hospitalisation; specific questions NR |
| Hux et al (2009)38
38.
Hux,
K
∙
Schneider,
T
∙
Bennett,
K
Screening
for
traumatic
brain
injury
Brain
Inj.
2009;
23:8-14
|
USA | Cross-sectional | Homeless shelters and domestic violence facility | 282 | 34·8 | 248/282 (87·9%) | 69/282 (24·5%) | . | . | Questionnaire or screening tool: HELPS screening tool |
| Hwang et al (2008)39
39.
Hwang,
SW
∙
Colantonio,
A
∙
Chiu,
S
∙
et
al.
The
effect
of
traumatic
brain
injury
on
the
health
of
homeless
people
CMAJ.
2008;
179:779-784
|
Canada | Cross-sectional | Shelters and meal programmes | 904 | 37·4 | 303/904 (33·5%) | 475/904 (52·5%) | 109/904 (12·1%) | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?”; additional injury details for up to three injuries were collected |
| Kim et al (2007)40
40.
Kim,
DK
∙
Jwa,
CS
∙
Kim,
GH
∙
et
al.
An
experience
of
management
of
homeless
neurosurgical
patients
J
Korean
Neurosurg
Soc.
2007;
42:191-194
|
South Korea | Retrospective case-control | Hospital neurosurgical department | 76 | 53% were >50 | 5/76 (6·6%) | . | . | . | Medical record |
| Kozloff et al
(2016)41
41.
Kozloff,
N
∙
Stergiopoulos,
V
∙
Adair,
CE
∙
et
al.
The
unique
needs
of
homeless
youths
with
mental
illness:
baseline
findings
from
a
housing
first
trial
Psychiatr
Serv.
2016;
67:1083-1090
|
Canada | Cross-sectional | Community agencies that serve homeless individuals (shelters, drop-in centres, outreach teams, inpatient programmes, and criminal justice programmes) in five Canadian cities | 2255 | 40·9 | 730/2255 (32·4%) | 1475/2255 (65·4%) | . | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?” |
| LePage et al (2014)42
42.
LePage,
JP
∙
Bradshaw,
LD
∙
Cipher,
DJ
∙
et
al.
The
effects
of
homelessness
on
Veterans'
health
care
service
use:
an
evaluation
of
independence
from
comorbidities
Public
Health.
2014;
128:985-992
|
USA | Retrospective case-control | VA North Texas Health Care System | 2205 | 53·6 | 121/2205 (5·5%) | . | . | 0·5% over 1 year | Medical record: ICD-9 codes |
| Mackelprang et al
(2014)43
43.
Mackelprang,
JL
∙
Harpin,
SB
∙
Grubenhoff,
JA
∙
et
al.
Adverse
outcomes
among
homeless
adolescents
and
young
adults
who
report
a
history
of
traumatic
brain
injury
Am
J
Public
Health.
2014;
104:1986-1992
|
USA | Cross-sectional | Homeless shelters, drop-in centres, domestic violence shelters, streets | 2732 | 21·8 | 1730/2732 (63·3%) | 1175/2732 (43·0%) | . | . | Single question or series of questions: “Have you ever been hit in the head so hard that you saw stars or were knocked unconscious—for example, from a blow, a fall, or a motor vehicle accident?” and “After your head injury, did you start having problems with headaches, concentration or memory, understanding, excessive worry, sleeping, or getting along with people?” |
| McCormick and White
(2016)44
44.
McCormick,
B
∙
White,
J
Hospital
care
and
costs
for
homeless
people
Clin
Med
(Lond).
2016;
16:506-510
|
UK | Retrospective case-control | Hospital admissions records | 7830 hospital admissions in 2010–11 | 38·7 over the study period | 20% over study period | . | . | 2·1% of hospital admissions (2010–11) in the homeless group were for head injury | Medical record: National Health Service hospital episode statistics in England |
| McMillan et al
(2015)45
45.
McMillan,
TM
∙
Laurie,
M
∙
Oddy,
M
∙
et
al.
Head
injury
and
mortality
in
the
homeless
J
Neurotrauma.
2015;
32:116-119
|
UK | Retrospective case-control | Hostels and other designated accommodations for homeless individuals | 1590 | 40·5 | 347/1590 (21·8%) | . | . | 13·5% over 30 years | Medical record: ICD-9 and ICD-10 codes |
| Montgomery et al
(2015)46
46.
Montgomery,
AE
∙
Dichter,
ME
∙
Thomasson,
AM
∙
et
al.
Disparities
in
housing
status
among
veterans
with
general
medical,
cognitive,
and
behavioral
health
conditions
Psychiatr
Serv.
2015;
66:317-320
|
USA | Retrospective case-control | Veterans Health Administration clinical and administrative systems | 11 909 | NR | NR | . | . | . | Medical record |
| Nielssen et al
(2018)20
20.
Nielssen,
OB
∙
Stone,
W
∙
Jones,
NM
∙
et
al.
Characteristics
of
people
attending
psychiatric
clinics
in
inner
Sydney
homeless
hostels
Med
J
Aust.
2018;
208:169-173
|
Australia | Retrospective chart review | Mental health clinics in three hostels for homeless individuals | 2388 | 42·3 | 156/2388 (6·5%) | . | 345/2388 (14·4%) | . | Medical record |
| Nikoo et al (2015)47
47.
Nikoo,
N
∙
Motamed,
M
∙
Nikoo,
MA
∙
et
al.
Chronic
physical
health
conditions
among
homeless
J
Health
Dispar
Res
Pract.
2015;
8:81-97
|
Canada | Cross-sectional | Emergency shelters and streets | 500 | 37·9 | 200/500 (40·0%) | 318/500 (63·6%) | . | . | Single question or series of questions: specific questions NR |
| Nikoo et al (2017)48
48.
Nikoo,
M
∙
Gadermann,
A
∙
To,
MJ
∙
et
al.
Incidence
and
associated
risk
factors
of
traumatic
brain
injury
in
a
cohort
of
homeless
and
vulnerably
housed
adults
in
3
Canadian
cities
J
Head
Trauma
Rehabil.
2017;
32:E19-E26
|
Canada | Prospective longitudinal | Shelters, meal programmes, community health centre, and drop-in centres in three Canadian cities | 1190 | 42·2 | 385/1190 (32·4%) | 718/1190 (60·3%) | . | 19·4% at 1-year follow-up; 17·1% at 2-year follow-up; 17·9% at 3-year follow-up | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?” |
| Noël et al (2016)49
49.
Noël,
F
∙
Moniruzzaman,
A
∙
Somers,
J
∙
et
al.
A
longitudinal
study
of
suicidal
ideation
among
homeless,
mentally
ill
individuals
Soc
Psychiatry
Psychiatr
Epidemiol.
2016;
51:107-114
|
Canada | Prospective longitudinal | Community agencies that serve homeless individuals (shelters, drop-in centers, outreach teams, inpatient programmes, and criminal justice programmes) in five Canadian cities | 497 | 40·8 | 138/497 (27·8%) | . | . | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?” |
| Oddy et al (2012)50
50.
Oddy,
M
∙
Moir,
JF
∙
Fortescue,
D
∙
et
al.
The
prevalence
of
traumatic
brain
injury
in
the
homeless
community
in
a
UK
city
Brain
Inj.
2012;
26:1058-1064
|
UK | Cross-sectional | Dry hostels, wet hostels, and day centres for homeless individuals | 100 | 32·7 | 25/100 (25·0%) | 48/100 (48·0%) | 12/65 (18·5%) | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?”, with additional questions regarding the number of injuries, LOC and whether participants went to the hospital for the first three injuries |
| Palladino et al
(2017)51
51.
Palladino,
B
∙
Montgomery,
AE
∙
Sommers,
M
∙
et
al.
Risk
of
suicide
among
veterans
with
traumatic
brain
injury
experiencing
homelessness
J
Mil
Veterans
Health.
2017;
25:34-38
|
USA | Cross-sectional | Homeless outreach services, including a VA medical centre and drop-in centre for veterans experiencing homelessness | 103 | 53·7 | 0/103 | . | . | . | Structured interview and questionnaire or screening tool: OSU TBI-ID and TBI-4 tools |
| Russell et al
(2013)52
52.
Russell,
LM
∙
Devore,
MD
∙
Barnes,
SM
∙
et
al.
Challenges
associated
with
screening
for
traumatic
brain
injury
among
US
veterans
seeking
homeless
services
Am
J
Public
Health.
2013;
103:S211-S212
|
USA | Cross-sectional | Metropolitan VA hospital | 678 | 51·9 | 36/678 (5·3%) | 285/313 (91·1%) | . | . | Structured interview and questionnaire or screening tool: OSU TBI-ID and TBI-4¶ |
| Schmitt et al
(2017)53
53.
Schmitt,
T
∙
Thornton,
AE
∙
Rawtaer,
I
∙
et
al.
Traumatic
brain
injury
in
a
community-based
cohort
of
homeless
and
vulnerably
housed
individuals
J
Neurotrauma.
2017;
34:3301-3310
|
Canada | Cross-sectional | Single-room occupancy hotel rooms and downtown community court | 283 | 43·5 | 47/205 (22·9%) | 100/283 (35·3%) | 49/283 (17·3%) | . | Single question or series of questions: “Have you ever had a serious head/face injury?”, with additional questions regarding LOC, confusion, or memory loss post injury |
| Solliday-McRoy et al
(2004)54
54.
Solliday-McRoy,
C
∙
Campbell,
TC
∙
Melchert,
TP
∙
et
al.
Neuropsychological
functioning
of
homeless
men
J
Nerv
Ment
Dis.
2004;
192:471-478
|
USA | Cross-sectional | Homeless shelter | 90 | 41 | 0/90 | 43/90 (47·8%) | 16/90 (17·8%) | . | Single or series of questions: specific questions NR |
| Song et al (2018)55
55.
Song,
MJ
∙
Nikoo,
M
∙
Choi,
F
∙
et
al.
Childhood
trauma
and
lifetime
traumatic
brain
injury
among
individuals
who
are
homeless
J
Head
Trauma
Rehabil.
2018;
33:185-190
|
Canada | Cross-sectional | Shelters, homeless outreach services, and streets in three Canadian cities | 500 | 38 | 200/500 (40·0%) | 318/500 (63·6%) | . | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?'” |
| Stergiopoulos et al
(2015)56
56.
Stergiopoulos,
V
∙
Cusi,
A
∙
Bekele,
T
∙
et
al.
Neurocognitive
impairment
in
a
large
sample
of
homeless
adults
with
mental
illness
Acta
Psychiatr
Scand.
2015;
131:256-268
|
Canada | Cross-sectional | Community agencies that serve homeless individuals (shelters, drop-in centres, outreach teams, inpatient programmes, and criminal justice programmes) in five Canadian cities | 1500 | 41·1 | 477/1500 (31·8%) | . | 688/1500 (45·9%) | . | Single question or series of questions: specific questions NR |
| Svoboda and Ramsay
(2014)57
57.
Svoboda,
T
∙
Ramsay,
JT
High
rates
of
head
injury
among
homeless
and
low-income
housed
men:
a
retrospective
cohort
study
Emerg
Med
J.
2014;
31:571-575
|
Canada | Retrospective cohort | Wet shelter programme, hostel for homeless individuals, and three low-income housing sites | 170 | 43·7 | 0/170 | . | . | 28·8% (participants in wet shelters); 3·3% (participants in hostels); and 5·1% (participants in low-income housing) over 1 year | Medical record: broad criteria to capture “head injury” |
| To et al (2015)58
58.
To,
MJ
∙
O'Brien,
K
∙
Palepu,
A
∙
et
al.
Healthcare
utilization,
legal
incidents,
and
victimization
following
traumatic
brain
injury
in
homeless
and
vulnerably
housed
individuals:
a
prospective
cohort
study
J
Head
Trauma
Rehabil.
2015;
30:270-276
|
Canada | Prospective longitudinal | Shelters and meal programmes for homeless individuals | 1181 | 43 | 382/1181 (32·3%) | 718/1181 (60·8%) | . | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?” |
| Topolovec-Vranic et al
(2014)59
59.
Topolovec-Vranic,
J
∙
Ennis,
N
∙
Howatt,
M
∙
et
al.
Traumatic
brain
injury
among
men
in
an
urban
homeless
shelter:
observational
study
of
rates
and
mechanisms
of
injury
CMAJ
Open.
2014;
2:e69-e76
|
Canada | Cross-sectional | Shelter for homeless men | 111 | 54·2 | 0/111 | 50/111 (45·0%) | 46/111 (41·4%) | . | Questionnaire or screening tool: Brain Injury Screening Questionnaire |
| Topolovec-Vranic et al
(2017)60
60.
Topolovec-Vranic,
J
∙
Schuler,
A
∙
Gozdzik,
A
∙
et
al.
The
high
burden
of
traumatic
brain
injury
and
comorbidities
amongst
homeless
adults
with
mental
illness
J
Psychiatr
Res.
2017;
87:53-60
|
Canada | Cross-sectional | Community agencies that serve homeless individuals (shelters, drop-in centers, outreach teams, inpatient programmes, criminal justice programmes) in five Canadian cities | 2088 | 40·9 | 657/2088 (31·5%) | 1098/2088 (52·6%) | . | . | Single question or series of questions: “Have you ever had an injury to the head which knocked you out or at least left you dazed, confused, or disoriented?”, “Were you, in fact, knocked out or unconscious after this (or any of these if more than 1 head injury(ies)?”, and “About how long were you unconscious or knocked out after this head injury (if 1)/these head injuries (if >1)?”, with additional questions regarding the length of LOC for up to five injuries |
| Vila-Rodriguez et al
(2013)19
19.
Vila-Rodriguez,
F
∙
Panenka,
WJ
∙
Lang,
DJ
∙
et
al.
The
hotel
study:
multimorbidity
in
a
community
sample
living
in
marginal
housing
Am
J
Psychiatry.
2013;
170:1413-1422
|
Canada | Prospective longitudinal | Single-room occupancy hotel rooms | 293 | 44·1 | 68/293 (23·2%) | . | 31/293 (10·6%) | . | Other: evidence of previous TBI on MRI or history of TBI (LOC for ≥5 min or confusion for ≥1 day) and persistent symptoms referable to TBI, including seizures or organic personality disorder |
| Zieman et al (2017)61
61.
Zieman,
G
∙
Bridwell,
A
∙
Cárdenas,
JF
Traumatic
brain
injury
in
domestic
violence
victims:
a
retrospective
study
at
the
barrow
neurological
institute
J
Neurotrauma.
2017;
34:876-880
|
USA | Retrospective chart review | Central neurology clinic cohort of referred patients from homeless shelters with TBI as a result of domestic violence | 115 | 37·9 | 109/115 (94·8%) | . | . | . | Questionnaire or screening tool: HELPS screening tool |
| Zlotnick et al
(1995)62
62.
Zlotnick,
C
∙
Fischer,
PJ
∙
Agnew,
J
Perceptuomotor
function
of
homeless
males
in
alcohol
rehabilitation
J
Subst
Abuse.
1995;
7:235-244
|
USA | Cross-sectional | Rehabilitation programme for homeless individuals recovering from alcohol misuse | 52 | 60% were >35 | 0/52 | 21/52 (40·4%) | . | . | Single question or series of questions: specific questions NR |
| Studies | Participants | Estimated prevalence, % (95% CI) | Heterogeneity | Change in estimated prevalence from univariable meta-regression analyses* | Change in estimated prevalence from multivariable meta-regression analysis* | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| I2 | p value | Change, % (95% CI) | p value | Change, % (95% CI) | p value | |||||
| Measure of central tendency of age for the study sample | 18 | 9702 | 52·1% (46·4–59·7) | 97% | <0·0001 | 1·5% (−4·7 × 10−2 to 3·1) | 0·058 | 1·6% (2·7 × 10−2 to 3·2) | 0·045 | |
| Sample size | 18 | 9702 | 52·1% (46·4–59·7) | 97% | <0·0001 | 5·3 × 10−3% (−1·6 × 10−2 to 2·6 × 10−2) | 0·49 | 1·8 × 10−2% (3·6 × 10−4 to 3·6 × 10−2) | 0·047 | |
| Site of study recruitment | ||||||||||
| Service or clinic | 6 | 2855 | 64·7% (48·2–78·3) | 95% | <0·0001 | Reference | . | Reference | . | |
| Shelter or hostel | 12 | 6847 | 47·4% (41·1–53·7) | 95% | <0·0001 | −39·4% (−66·7 to −12·1) | 0·0047 | 3·6% (−31·4 to 38·1) | 0·85 | |
| TBI ascertainment method | ||||||||||
| Single question or series of questions | 13 | 8821 | 50·1% (43·7–56·5) | 97% | <0·0001 | −25·0% (−57·6 to 7·7) | 0·13 | Reference | . | |
| Other screening tool (HELPS or BISQ) | 2 | 393 | 33·8% (17·1–55·9) | 94% | <0·0001 | −47·8% (−90·8 to −4·8) | 0·029 | −32·7% (−73·1 to 7·6) | 0·11 | |
| OSU TBI-ID structured interview | 3 | 488 | 78·0% (53·4–91·6) | 95% | <0·0001 | 73·6% (37·4 to 100·0) | <0·0001 | 67·9% (22·3 to 100·0) | 0·0035 | |

30188-4/asset/6b3aaa8b-87cb-4726-a213-e4157b682389/main.assets/gr1.gif)
30188-4/asset/6b3aaa8b-87cb-4726-a213-e4157b682389/main.assets/gr1.gif)
30188-4/asset/4bb7d778-e9fc-4738-9dcd-50a0ab0a114e/main.assets/gr2.jpg)

